OREGON UNIVERSITY CLASS/COMP STUDY UNION COMMENTS

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1 OREGON UNIVERSITY CLASS/COMP STUDY UNION COMMENTS ALLIED HEALTH JOB FAMILY Medical Assistant General Comments Rather than a single Medical Aide classification, there should be two classifications, Medical Aide and Medical Assistant, with Medical Assistant to be applicable to both Certified and Registered Medical Assistants, consistent with health care industry practices. These employees have special training in ambulatory care that Medical Aides do not have. Their training and their work is integral to the operation and functioning of Student Health Clinics. For example, Certified Medical Assistants draw blood (phlebotomy); instruct patients on collecting stool samples; do x-rays in some cases; perform EKGs, ear lavages. tests for tuberculosis and CBG's (capillary blood glucose tests); fit patients with durable medical equipment such as slings and wrist splints; perform eye exams; make results calls; give patients nebulizer treatments; and, in some cases, give injections, such as immunizations and Depo provera birth control. At SHAC at PSU, Medical Assistants are assigned to the CLIA Waved Lab. These employees draw blood per provider orders, input lab orders and transmit specific tests to Quest Diagnostics throughout the day; perform CLIA Waved tests, document and record results and perform controls for all CLIA Waved tests. Medical Assistants input diagnosis codes and place charges in Electronic Medical Records for all procedures performed. SHAC does not have a Lab Technician; Medical Assistants perform those duties. SHAC also has on-site X-ray and Medical Assistants who perform Limited Scope of X-ray and must be certified by OBMI, The Oregon Board of Medical Imaging. There are State and National certifications for CMAs. Medical Assistants must pass State exams and be proficient in these scopes of practice. Also, Medical Assistants with X-ray have additional education and testing and must sit and pass State boards for each of the six licenses that are possible in the scope of Limited X-ray. There needs to be clear distinction and compensation for this classification. Essential Duties Medical Assistants generally do not deliver or pick up medications so this should not be listed as part of the Essential Duties. Minimum Qualifications The Minimum Qualifications as stated in the class specification are appropriate for a Medical Aide classification, but not for a Medical Assistant classification.

2 Radiologic Technologist The Minimum Qualifications in the draft class specification as written do not make it clear whether employees are required to be fully licensed radiologic technologists, as opposed to limited permit techs. It is important to make this distinction. Registered Nurse General Comments In general, the draft classification specifications for Registered Nurse describe the duties of RN1s adequately but do not capture the higher-level responsibilities of the current RN2s. Overall, nurses see clear distinctions between these two levels of work. Combining the RN1 and RN2 classifications into a single Registered Nurse classification is a mistake. Currently, an RN1 has a career path to RN2. RN 2 has a pay differential of approximately 10% over RN 1 (two salary ranges). These two levels are distinct and need to remain separate classifications. RN2s act as lead workers and are essential for the safe day-to-day operations of the university health center. Assignment of such duties to RN2s ensures the smooth flow of patient care, and coordination between doctors and nursing staff. RN 2s coordinate staff and resources in the separate clinics and conduct the communications with other clinics in the health center. An RN2 has a more complex and demanding position than an RN 1, which requires overseeing nursing operations; facilitating orientation of new nursing staff; giving presentations in staff meetings or in-service training sessions on new or specialized procedures or health care techniques; and may include speaking to hospitals, community groups, health care agencies, church groups and schools to provide education on current practices, procedures, medical breakthroughs. RN2's have responsibility for making operational decisions consistent with health center policies, for assisting in monitoring and meeting departmental budgets, writing policies and procedures, and facilitating orientation for nursing staff. Combining the RN 1 and RN 2 classifications into a single classification creates an unsafe clinical environment and removes an important element of care coordination. In fact, many RNs contend that, rather than deleting the distinction between RN 1 and RN 2, an RN3 classification should be added to reflect higher-level case-management responsibilities and patient load assignments. Distinguishing Characteristics: The term "nursing regimens" is an unknown term to RNs and is not a term generally used in the health care industry. The class specifications should use terminology that is unambiguous and easy to understand.

3 Essential Duties: The first paragraph under the Essential Duties section of the RN draft class specification includes the phrase "interpreting health histories, symptoms, physical findings or diagnostic information." This phrase sounds diagnostic and is not the correct terminology. Nurses "assess and evaluate" only; they do not diagnose. The essential duty should therefore read, "As assigned, assesses patient's status by interviewing; assessing and evaluating health histories, etc. The second paragraph under Essential Duties refers to participates or contribute feedback on staff evaluations. This is a lead worker duty and should be part of the work of an RN 2 classification. The third paragraph under the Essential Duties includes the phrase create and revise patient treatment plans. Again use of "patient treatment plan" is more appropriate for doctor's duties; the appropriate terminology for RNs is a "nursing care plan." Another duty not listed in the Essential Duties which should be included is the responsibility to write and revise nursing care policies and procedures. Under both Distinguishing Characteristics and Essential Duties, patient education should be included as a primary role. Patient education is mentioned twice in essential duties: counseling and educating patients about drug regimens and side effects, and providing health education. However, this reference is too narrow, as nurses provide education on a regular basis on diverse topics. Advances in medical record systems should also be reflected in the class spec. All patient care staff now work with electronic medical records (EMR). USSE should also consider adding the following wording adapted from the current class specification to the Essential Duties section. Application of nursing process: Typical tasks: assesses patient's psychological and physical condition, assesses treatment needs and develops nursing care plan including such things as nursing interventions, teaching plan and discharge plan; collaborates with others in providing client services; prioritizes and carries out therapeutic treatment prescribed by the nursing care plan and evaluates response to treatment. Education. Typical tasks: educates patients and their families about their Illness or disease process as well as community health topics and activities, pre and post-operative process and orientation to the hospital ward, operating room or birthing room; educates patients and/or their families in post-hospital care such as how to bathe, clean wounds and change dressings, feedings, suction and care for tracheotomies, care for sutures and catheters, taking vital signs and glucose levels, mobility, skin care, pain control, medication administration such as insulin or antibiotics, operation of home monitors,

4 CPR for parents of premature babies, parenting skills, breast feeding, contraception, nutrition, and diet; participates in providing learning. Licensing/Certifications: The word "Professional" should be eliminated from the reference to the RN license, as it is not part of the legal description of the license. Minimum Qualifications The MQs for RN are appropriate for an RN 1; however an RN2 should have a number of years of charge nurse or equivalent experience. UO currently requires five years RN experience and two years charge nurse or experience in supervision of a health care team. It should be recognized that an RN1 filling in regularly for an RN2 Lead gains the supervisory experience needed to apply for RN2 job postings. The MQs for RN2 could include a BSN or related field like Bachelor's in Health Care Administration. Licensing/Certifications The word professional should be deleted as it is not part of the RN license. Advanced Practice Clinician General Comments The Advanced Practice Clinician classification combines Nurse Practitioners and Physician s Assistants into a single classification, and includes it as the third level in a nursing classification series. (The current Mid-Level Medical Practitioner classification also combines these two occupations into a single classification.) There are a number of problems with this approach. There are many important distinctions between Physicians Assistants and Nurse Practitioners which make it problematical to combine them into a single classification. Nurse Practitioners and Physician s Assistants have a similar scope of practice, but their training and backgrounds are very different. Nurse Practitioners are independent clinicians who provide primary care, including physical examinations and various office procedures. They work independently of physician and do not in any way assist physicians. This also includes diagnosing patients, not tentative diagnosis, as the draft class specification states. Physician s Assistants are primary care providers who perform patient history, examinations, make a diagnosis after consideration of a differential diagnosis, order labs and imaging tests and interpret the results, make treatment plans including prescription drugs including schedule II-V, provide patient education and refer patients to specialists as appropriate.

5 Physicians Assistants and Nurse Practitioners also have different licensing and educational requirements. Physician Assistants are not nurses and do not have training or education in nursing. They are licensed under the Board of Medical Examiners, while Nurse Practitioners are licensed under the Board of Nursing. Consideration should also be given to treating these classifications as stand-alone classifications, rather than as part of the nursing series. Essential Duties/Distinguishing Characteristicss The third paragraph under the Essential Duties section of the Advanced Practice Clinician classification refers to providing tentative diagnoses and treatment. The use of the word tentative here is not accurate or appropriate. These employees provide diagnoses and treatment which are not tentative. Also, the fifth paragraph under this section refers to "assist(ing) physicians in conducting physical exams, which includes taking vital signs, preparing injections, and assisting with necessary medical procedures." This is also inaccurate. These employees do not assist physicians in performing these procedures, but perform them independently. This statement is more reflective of the work of a Registered Nurse, rather than either a Nurse Practitioner or a Physician s Assistant. The following should be added to this section: Performs physical exams, which includes taking vital signs, preparing and administering injections, and performing necessary medical procedures within the practitioner's scope of practice and training. Also under the Distinguishing Characteristics section, the use of the word "biopsies" should be replaced with medical procedures. These employees do many types of procedures beyond biopsies. A more appropriate statement for this section would be something like the following: Responsibilities may include patient examination; microscopic examination of samples; blood draws; minor surgical procedures, including, but not limited to biopsies, laceration repair, incision and drainage, and IUD and Nexplanon insertions and removals; lab studies; providing primary medical care including history taking, examinations, differential diagnosis, lab and imaging orders and interpretation of results, treatment plans, prescription of medications including schedule II-V drugs, patient education, and referral to specialists as indicated. Also may include provision of training of other health professionals or professional students. Minimum Qualifications The Minimum Qualifications as stated on the draft class specification for the Advanced Practice Clinician classification are as follows: Associate s or Bachelor s degree in Nursing or Physician s Assistant and advanced education consistent with obtaining the State of Oregon licenses and certifications listed below:

6 --Oregon Professional Registered Nurse licensure and valid Nurse Practitioner certification issued by the Oregon State Board of Nursing ; or --Oregon Physician Assistant licensure and successful completion of an accredited national certification exam as required by the State of Oregon Board of Medical Examiners. We suggest replacing the wording in the first paragraph cited above with the following: Masters Degree in Nursing or Masters of Physician Assistant from an accredited program OR advanced education consistent with obtaining the state of Oregon licenses and certification listed below. --Oregon Professional Registered Nurse licensure and valid Nurse Practitioner certification approved by the Oregon State Board of Nursing ; or --Oregon Physician Assistant licensure and successful completion of an accredited national certification exam as required by the State of Oregon Board of Medical Examiners. This language will grandfather in those with certificate programs as Nurse Practitioners or the bachelor degree PA. Both Nurse Practitioners and Physicians Assistants have required a Master's Degree for many years. However, there are still some practicing clinicians that have been grandfathered in with an associate or bachelor's degree, prior to the change in requirements by the Board of Nursing and the board of Medical Examiners. Regarding Nurse Practitioner certification, OSBN does not issue certifications; rather there are various national certification organizations which are approved by OSBN. Knowledge The word protocol should be removed from the phrase medical treatment protocols and practices. The phrase nursing principles and practices does not apply to Physicians Assistants. This illustrates the logic behind splitting this classification into two: Nurse Practitioner, which does require knowledge of nursing principles and practices and Physician s assistant, which does not. General Comments Nursing Series It is questionable whether LPN, RN1, RN2 and Advanced Practice Clinician should be a nursing series. The training and licensure are quite different. USSE should consider making these stand-alone classifications as is the practice in the private sector.

7 In general, there is major concern among nursing staff that combining classifications will adversely impact pay rates in the future, especially if higher level duties are not adequately reflected in the class specifications. General Comment All Allied Health Classifications Licensing/Certifications The reference to "HIPPA and FERPA" should be moved from Licensing/Certifications to Minimum Qualifications as this is not a Licensing/Certification issue per se. Also the acronym HIPAA is misspelled. Working Conditions The Working Conditions section of all of the class specifications in the Allied Heath job family include the words fingering and feeling. It is not clear what is meant by these words. Also the following should be added to all direct patient care classifications: May be exposed to blood and other bodily fluids and infectious diseases.

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